Thursday, September 20, 2007

Back To Work 1: shades of nights past

I have now been well and truly blooded in the deep-immersion technique of returning to surgery, feet first, into the deep end. In fact, I exaggerate. It felt, for the months leading up to this entry, that it would be extremely deep and extremely bloody, but this is not a war zone. The denizens of my particular corner of the city seem to be maintaining a truce in the gun and stabbing battles that can so excite those of us employed to clean up afterwards. Either that, or they have got better at finishing off their victims, and bypassed us altogether for the more direct line to the morgue. My nights have involved so far the usual grist to the surgical mill of appendices inflamed and not inflamed along with abscesses - hundreds of years of lancing the spectacular things. One has to treasure the operations that necessarily bring you thanks. Most of our interventions hurt and need explaining. However there are a few that bring instant relief: relieving your buttock abscess of an acre of pus; catheterising a man in acute retention of urine, though messy and now, one would hope, rather below me after years of it. All lead to effusive gratitude. Of course, now that they have deprived our wards of all doctors except me, I will again be catheterizing when it is beyond the capabilities of the excellent, yet often hassled nurses (now "clinical site managers").

So this is what has changed: as a houseman, now 13 years ago (wince), I was the sole mistress of the wards. In charge at night of all wards and all admissions with only some tetchy and off-putting seniors to call and woe betide if my story wasn't good, and my investigations done. As an SHO, the next level up in the recently-replaced system, the housemen began to be put to bed and once again, I was the doctor in charge at night. Going round, sorting out the serious and the bog-standard annoying. Admitting and sitting on those not serious enough to wake my tetchy and demanding senior about.
I now return to active service, only to find that the SHOs, too, are in bed now. At the elevated role of Registrar, I would, once have been the tetchy one in bed but am now wandering around the wards keen to find someone to incise and drain or laparotomise to give me an excuse to avoid the drudgery they are so keen to thrust upon me.
It makes me worry slightly about the next leap up, should I make it thus far: the ultimate goal of consultant, the "attending" of the US hierarchy. When we started, they were noble figures, rarely glimpsed and obsequiously bowed-before. The yearly party hosted by them at their pads were more a chance to show off the prizes of sticking the middle years - swimming pool, racing cars, luxurious space and wine. It was supposed to be your inspiration. The standards have been slipping recently, one must admit. More likely a semi in Muswell Hill than Hampstead splendour. But now, having worked this system and expected their last twenty years to be of semi-retired elective advice as the generation before them, they are in supervising a rusty surgical girl sharpening up her knives for a measly little appendix.

What's come back? Oh the tying of knots, the laying on of hands. What's decayed? Memory, my once ace card, now a little frayed at the edges; non-surgical know-how. My, how it's moved on in my absence!
Part 2: But what about the kids?

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